Smartphone Apps Provide a Simple, Accurate Bedside Screening Tool for Orthostatic Tremor

Gerpen

2016

Background: Orthostatic tremor (OT) and orthostatic myoclonus (OM) are weight-bearing hyperkinetic movement disorders most commonly affecting older people that induce ''shaky legs'' upon standing. OT is divided into ''classical'' and ''slow'' forms based on tremor frequency. In this paper, the first joint review of OT and OM, we review the literature and compare and contrast their demographic, clinical, electrophysiological, neuroimaging, pathophysiological, and treatment characteristics. Methods: A PubMed search up to July 2016 using the phrases ''orthostatic tremor,'' ''orthostatic myoclonus,'' ''shaky legs,'' and ''shaky legs syndrome'' was performed. Results: OT and OM should be suspected in older patients reporting unsteadiness with prolonged standing and/or who exhibit cautious, wide-based gaits. Surface electromyography (SEMG) is necessary to verify the diagnoses. Functional neuroimaging and electrophysiology suggest the generator of classical OT lies within the cerebellothalamocortical network. For OM, and possibly slow OT, the frontal, subcortical cerebrum is the most likely origin. Clonazepam is the most useful medication for classical OT, and levetiracetam for OM, although results are often disappointing. Deep brain stimulation appears promising for classical OT. Rolling walkers reliably improve gait affected by these disorders, as both OT and OM attenuate when weight is transferred from the legs to the arms. Discussion: Orthostatic hyperkinesias are likely underdiagnosed, as SEMG is often unavailable in clinical practice, and thus may be more frequent than currently recognized. The shared weight-bearing induction of OT and OM may indicate a common pathophysiology. Further research, including use of animal models, is necessary to better define the prevalence and pathophysiology of OT and OM, in order to improve their treatment, and provide additional insights into basic balance and gait mechanisms.

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Section: Electrophysiological Findingsmentioning

confidence: 99%

Orthostatic Tremor and Orthostatic Myoclonus: Weight-bearing Hyperkinetic Disorders: A Systematic Review, New Insights, and Unresolved Questions

Gerpen

2016

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“…39 Given limited access to electrophysiology studies in some clinical settings, emerging use of new technologies, such as app-based tremor devices which have been found to be highly sensitive in OT, can increase bedside detection. 43 …”

Section: Resultsmentioning

confidence: 99%

Slow Orthostatic Tremor: Review of the Current Evidence

Caviness

2019

“…Therefore, spectral power analysis may be a simple, quick method to screen for OT 69. A smart phone accelerometry app has also been reported to detect OT and holds promise as an easy, cheap, and sensitive screening tool 70. Posturography is being studied in OM patients, but the data are preliminary.…”

Section: Resultsmentioning

confidence: 99%

Orthostatic Tremor and Orthostatic Myoclonus: Weight-bearing Hyperkinetic Disorders: A Systematic Review, New Insights, and Unresolved Questions

Gerpen

2016